A comprehensive analysis and literature review of vertebral artery variation in craniovertebral junction using three-dimensional computed tomography angiography

Abstract

Purpose: To describe vertebral artery (VA) variation in patients with or without osseous anomalies at congenital craniovertebral junction (CVJ).

Methods: In the present study, we retrospectively analyzed 258 patients with VA variation who underwent three-dimensional computed tomography angiography (3D CTA) in our hospital from March 2017 to October 2019.

Results: Among 258 patients, 180 were accompanied by skeleton structural malformation, including 105 cases of occipital ossification of the atlas, 8 cases of the bipartite atlas, 7 cases of hypoplasia of the posterior arch of the atlas, 45 cases of C2/3 congenital fusion, 2 cases of C2/3/4 congenital fusion, and 13 cases of congenital os odontoid. VA variation was divided into type A (VA variation in the CVJ area without osseous anomalies) and type B (VA variation in the CVJ area with osseous anomalies). There are totally 10 subtypes, including type A1 (atlas occipitalization with VA entrance approach close to middle line, 20.2%); type A2 (atlas occipitalization with VA entrance approach far from middle line, 30.2%); type A3 (first intersegmental VA in C1-C2, 1.9%); type A4 (fenestration of the VA, 2.3%); type A5 (VA bulging type, 6.6%); type A6 (VA exposures with the absence of the posterior atlas arch, 2.3%); type A7 (C2 inner wall type, 0.4%); type A8 (single vertebral artery, 2.3%); type B1 (posterior ponticuli, 2.7%); and type B2 (high-riding VA, 31.4%).

Conclusion: This study is expected to take the lead in the most comprehensive classification of VA variation.

Keywords: 3D CTA; Craniovertebral junction; Osseous anomalies; Vertebral artery variation.